Tag Archives: STD Awareness

STD Awareness: Sexually Transmitted Diseases and Pregnancy

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Every month since January 2011, we’ve been sharing installments of our STD Awareness series, and each month, we’ve encouraged you to protect yourself from sexually transmitted diseases (STDs) by using dental dams and condoms. But what if you’re trying to get pregnant? In that case, you’re probably not using condoms! However, it is very important that partners know their STD status — being screened and treated for STDs prior to pregnancy is a good idea for your health, and can protect your future baby.

If you and a partner are trying to get pregnant, you might consider being screened for STDs together.

When present during pregnancy, certain STDs can have negative health effects for you or your future baby (including preterm labor, stillbirth, low birth weight, pneumonia, certain infections, blindness, and liver disease), especially if they are not cured or treated in time. Receiving prenatal care can help prevent these problems, so it is important to be screened and treated for STDs prior to or early in your pregnancy.

During pregnancy, the immune system undergoes changes, which are probably necessary to ensure that the body doesn’t reject the fetus — normally, the immune system recognizes non-self cells as potential pathogens and attacks. These immune system changes might make a pregnant person more susceptible to disease. Latent viral infections, like genital warts or herpes, might come out of dormancy. Additionally, anatomical changes lead to a larger exposed area of the cervix, which is potentially more vulnerable to initial infections. Continue reading →

STD Awareness: 10 Sexually Transmitted Diseases You Probably Don’t Know About

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Giardia lamblia, a microbe that can be transmitted sexually. Image: NIH

Gonorrhea and chlamydia go back to antiquity. Syphilis took hold in Europe during the late 15th century. Herpes wasn’t on most people’s radars until the early 1980s, and human papillomavirus (HPV) was relegated to relative obscurity in the popular imagination until the HPV vaccines made their debuts less than a decade ago.

Have you heard of CMV, chancroid, or donovanosis?

But there are still a handful of sexually transmitted diseases (STDs) that you might not know about. These include incredibly common infections, as well as those caused by pathogens you might have heard of but probably don’t associate with sexual transmission. They also include infections that are very rare here in Arizona but are much more common in other parts of the world. They all deserve a closer look.

10 Trichomoniasis: What is the most common curable STD? You might guess that it’s chlamydia or gonorrhea, but according to the Centers for Disease Control and Prevention, it’s trichomoniasis (also known as trich, pronounced “trick”). This infection is caused by Trichomonas vaginalis, a single-celled parasite that is actually pretty cute as far as microbes go. What’s not so cute is its propensity to attach to your cells and degrade their surfaces, which on a large scale can produce unpleasant symptoms. Continue reading →

STD Awareness: HPV in Males

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Human papillomavirus, or HPV, can affect both males and females.

Human papillomavirus, or HPV, affects people of all genders.

Whether it’s worries over Gardasil making girls go wild, or it’s somber discussion about cervical cancer, discourse about human papillomavirus (HPV) centers around its impact on females. But who are most of these females getting HPV from? For the most part, they’re getting it from male partners. And despite the fact that cervical cancer is the most common cancer associated with HPV, it is not the only one. A high-risk strain of HPV can lead to cancers of the penis, anus, mouth, and throat; additionally, there are strains of HPV that cause genital warts, which affect males and females equally. So why don’t males figure very prominently in discussions of HPV and the preventive vaccine, Gardasil?

Mouth, throat, penile, and anal cancers can all be caused by HPV.

Some people think that if they remain abstinent until marriage, they will be able to avoid sexually transmitted diseases (STDs) – but not very many people can say with certainty that their spouses have never had any other sexual partners. Eva Perón, the second wife of Argentine president Juan Perón and a leader in her own right, was made famous here by the musical Evita. According to physician and writer Shobha S. Krishnan, she died in 1952 of cervical cancer – the same fate that befell her husband’s first wife. Many believe that Juan Perón was the source of both women’s ultimately fatal HPV infections.

While one’s own sexual behavior can increase risk for acquiring an STD, it is not the only factor – the sexual history of one’s partner also plays an important role. HPV is especially tricky because there is currently no FDA-approved test for HPV in males – despite the fact that more than half of sexually active males are estimated to have been infected with HPV at some point in their lives. And, because it is so often asymptomatic, a male can carry this virus without knowing it, unwittingly infecting his partners. Continue reading →

STD Awareness: Viral Hepatitis

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Hepatitis A virus particles are pictured in this electron micrograph. Image: Betty Partin, CDC

Hepatitis A virus particles are pictured in this electron micrograph. Image: Betty Partin, CDC

Hepatitis isn’t commonly thought of as a sexually transmitted disease (STD) — for most people, hepatitis conjures images of contaminated food or unsanitary restaurants. But hepatitis should be on the radar of anyone who is sexually active. There are several different viruses that cause hepatitis, and some can be sexually transmitted, including hepatitis A (HAV), hepatitis B (HBV), and, to a lesser extent, hepatitis C (HCV).

While HBV is most efficiently transmitted through blood, it can also easily hitch rides from person to person via sexual fluids. However, we covered HBV in depth last year in observance of World Hepatitis Day. As May is Hepatitis Awareness Month, we’ll turn the spotlight on HAV and HCV for this month’s installment of our STD Awareness series.

Hepatitis A (HAV)

HAV spreads through fecal-oral contact and is more widespread in parts of the world with poor sanitation. It is relatively rare in the United States, although in 2003 there was a hepatitis A outbreak outside of Pittsburgh — the largest in the United States — that was traced to improperly washed raw scallions. All told, there were 650 confirmed illnesses and four deaths. HAV is very resilient and can survive outside a host for long periods of time – other foodstuffs it can contaminate include filter-feeding shellfish, which can concentrate HAV from contaminated seawater in their tissues. When these shellfish are undercooked, they can pack quite a punch as billions of virus particles are released into the unsuspecting diner’s body.

Vaccination against hepatitis A confers lifelong immunity while sparing you from illness caused by a natural infection.

Unfortunately, no matter how well you clean your fresh produce or how long you cook shellfish, certain sexual activities can increase your risk of acquiring HAV. As with intestinal parasites, which can be present in minuscule amounts of fecal matter, so too can virus particles be present in microscopic bits of feces. Oral contact with the anus (“rimming” or anilingus) is the riskiest activity in terms of HAV transmission — oral-genital contact can also do the trick, as can manual contact between the anus and the mouth. While hepatitis A outbreaks have been reported among MSM – men who have sex with men – populations, oral-anal contact is associated with increased risk for HAV infection regardless of sexual orientation. To reduce your risk of sexual HAV transmission, use latex condoms or dental dams during oral activities. HAV can also be transmitted via blood, and hepatitis A outbreaks have been reported among IV drug users. Continue reading →

STD Awareness: Genital Warts

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A computer model of the surface of HPV-11, a leading cause of genital warts. Image: Scripps Research Institute

Human papillomavirus (HPV) is a hot topic these days thanks to the advent — and attendant controversy — of Gardasil, the vaccine that protects against four strains of this sexually transmitted virus. Discourse centers around HPV-16 and HPV-18, the two HPV strains that together are responsible for 70 percent of cervical cancers and 90 percent of anal cancers. However, Gardasil also protects against HPV-6 and HPV-11, two HPV strains that aren’t associated with cancer but rather with 90 percent of genital warts. While genital warts don’t have the potential to cause cancer and death, they can be very upsetting to the people who develop them.

Every year in the United States, about $200 million is spent to treat genital warts.

Many strains of human papillomavirus can cause warts, and not all of them are sexually transmitted. For instance, HPV-1, HPV-2, and HPV-4 cause warts on the hands and feet and are spread by skin-to-skin contact. About 40 strains of HPV can be transmitted sexually – they are called “mucosal” strains because of their affinity for mucous membranes such as the skin found in the genital, anal, and oral regions. Ninety percent of cases of genital warts are caused by two strains of HPV: HPV-6 and HPV-11. Genital warts are highly contagious and can be transmitted by any type of sexual activity.

Let’s start with a quick overview of genital warts. While it’s quite possible for someone infected with a wart-causing strain of HPV to be completely asymptomatic, the physical appearance of warts can take several forms. They can appear in the genital area, in or around the anus, and (very rarely) in the mouth, lips, palate, or throat. They can also rarely be found on the cervix and vaginal walls. They are soft to the touch and can be raised, flat, or bumpy. They may or may not be itchy or painful. Genital warts can be small or quite large. As you can see, there are a wide variety of ways they can manifest themselves, despite being caused by one type of virus. There are four types:

  • condylomata acuminata, which have a “cauliflower-like” appearance
  • papular warts, which are dome-shaped papules 1-4 millimeters in diameter
  • keratotic warts, which have a thick, “crust-like” layer
  • flat-topped papules, which can look like a freckle or might be slightly raised from the surface of the skin

Genital warts usually develop within six weeks to six months after exposure, but could take longer to appear. If our immune systems are healthy, our bodies may be able to fight off the virus — our immune systems are normally able to clear 90 percent of genital-wart infections within two years of exposure. Unfortunately, if the immune system can’t fight off the virus, the infection will become chronic, in which case warts can resurface throughout one’s lifetime. The warts can be removed by a doctor, but you could still transmit the virus to others and you might experience a recurrence of the warts. Smokers’ immune systems are less likely to be able to fight off the infection, and in the case of a chronic infection, smokers’ warts are more likely to return even after being removed by a health care provider. Continue reading →

STD Awareness: Antibiotic-Resistant Gonorrhea

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Under the microscope, Neisseria gonorrhoeae infects larger human cells (click to enlarge). The bacteria resemble tiny pairs of coffee beans. Image: Dr. Norman Jacobs, CDC

Under the microscope, Neisseria gonorrhoeae infects larger human cells (click to enlarge). The bacteria resemble tiny pairs of coffee beans. Image: Dr. Norman Jacobs, CDC

Writing about sexually transmitted diseases (STDs), one must walk the line between warning readers of risks and engaging in full-fledged alarmism. So it’s a bit disconcerting that researchers writing in the New England Journal of Medicine last month declared that it’s “time to sound the alarm”: The emergence of completely antibiotic-resistant gonorrhea is becoming more of a realistic threat and less of a theoretical possibility. The bacteria that cause gonorrhea are evolving faster than we can develop effective antibiotics against them, and a return to the era of untreatable gonorrhea could see a rise in the particularly nasty complications that arise from a long-term gonorrheal infection, such as pelvic inflammatory disease and epididymitis.

There are genes that confer resistance to every single antibiotic we use to cure gonorrhea. If they all combine within one organism, we might have a superbug on our hands.

Neisseria gonorrhoeae is a species of tricky bacteria that cause gonorrhea, which can infect the mouth, throat, rectum, urethra, cervix, and even eyes. These bacteria have vexed us for thousands of years, having evolved many strategies for entrenching themselves in our bodies. They can alter the proteins that adorn their surfaces, rendering our immune systems incapable of recognizing them. They can form colonies in which they work together to manipulate our cell surfaces with their retracting appendages until they’re allowed entry inside, where they can surreptitiously multiply.

You’ve probably heard of MRSA, which is pronounced “mersa” and stands for methicillin-resistant Staphylococcus aureus — a strain of bacteria that has acquired resistance to methicillin, as well as pretty much every other antibiotic to boot. MRSA is an example of evolution by natural selection — what didn’t kill its ancestors made them stronger, spawning a drug-resistant strain.

Why are we talking about MRSA in a post about STDs? It’s not just because MRSA has apparently found a way to be transmitted sexually, but also because it helps make the concept of antibiotic-resistant gonorrhea more accessible. It wasn’t until less than a century ago that we finally developed a magic-bullet treatment for gonorrhea, and for a handful of decades it was quickly and easily treated with a dose of penicillin. Enter evolution by natural selection. Continue reading →

STD Awareness: “Can I Get an STD from Oral Sex?”

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As tools to reduce risk for STD transmission, dental dams are not to be ignored.

Many consider oral sex to be a safer form of sexual activity compared to vaginal or anal intercourse. For this reason, they might put less emphasis on the use of latex barriers, such as dental dams and condoms, during oral sex. Unfortunately, this idea is misguided and can lead to the transmission of preventable infections.

It is generally true that oral sex presents less of a risk for contracting sexually transmitted diseases (STDs) — but this risk is not trivial, especially when people are under the impression that they don’t need to use barrier methods during oral sex. Most sexually transmitted diseases can be passed along by oral sex, including chlamydia, gonorrhea, syphilis, hepatitis B, herpes (which can be transmitted back and forth from the mouth, as cold sores, to the genital region, as genital herpes), human papillomavirus (HPV), and HIV. Even pubic lice can be transferred from the genital region to eyelashes and eyebrows! Additionally, intestinal parasites are more likely to be transmitted via oral sex than through vaginal sex. A microscopic amount of fecal matter containing parasites can be infectious, and can be unknowingly ingested when present on genitals.

Seventy percent of adolescents who reported engaging in oral sex had never used a barrier to protect themselves from STDs during oral sex.

Some bacterial STDs, such as gonorrhea and syphilis, can do permanent damage if not treated in time. Furthermore, gonorrhea of the throat is much more difficult to treat than gonorrhea in the genital or rectal areas. And some viral STDs can’t be cured (such as herpes and HIV), while others can cause chronic infections that have been linked to cancer (such as hepatitis, which is associated with liver cancer, and HPV, which is associated with throat cancer as well as cervical cancer and anal cancer). Continue reading →

STD Awareness: Intestinal Parasites

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This colorized scanning electron micrograph shows Giardia lamblia reproducing asexually. Image: Stan Erlandsen, CDC’s Public Health Image Library.

This colorized scanning electron micrograph shows Giardia lamblia reproducing asexually. Image: Stan Erlandsen, CDC’s Public Health Image Library.

Most sexually transmitted diseases are caused by bacteria or viruses, but some are caused by organisms that are classified as completely different lifeforms. Trichomoniasis, for example, is caused by a protozoan organism; protozoa occupy their own kingdom, separate from plants, animals, and bacteria. Intestinal parasites are often protozoan organisms, but can also include parasitic worms (which are members of the animal kingdom). They are spread through contact with fecal matter – and as such, they can be transmitted sexually as well as nonsexually. Intestinal parasites are usually transmitted by fecal contamination of food or water, and are most common in areas with insufficient sewage treatment and untreated water in the wilderness. Some pathogens, however, have low infectious doses, making their sexual transmission more likely.

What has eight flagella and can live in your intestines?

Oral contact with the anus, also called anilingus or rimming, is the primary means of the sexual transmission of these pathogens. Putting fingers or hands in your mouth after they have had contact with the anus is also risky. Other modes of transmission include oral sex, as genitals can be contaminated with feces, as well as sharing sex toys and other equipment. For these reasons, it is very important to use dental dams or latex gloves during contact with the anus; to clean the anus before engaging in rimming; to clean or use condoms on shared sex toys; and to use condoms or dental dams during oral sex. Continue reading →